clexane during pregnancy

[Inanna]

Can you give some more info Tanya?

As you would know clexane is an anticoagulant - and as such "thins the blood"... This helps with placental development and function.

Severe reactions are rare and it is used frequently in women with recurrent miscarriage or in women that have had an otherwise unexplained stillbirth or late loss...

HTH...

[Tanya]

I have a client who has had two m/c. It was discovered that she had a clotting disorder and was put on clexane as well as low dose asprin. She is now due to give birth and the dr has told her she will be induced @ 39 weeks so they know that the clexane will be out of her system. Now from what I have read, she should be offered a lower dosage so she can go into spontaneous labour, however this option has not been given to her.

I would love to hear from anyone who had to be on the clexane up to the birth and again after wards.

Thanx Deb
xx

[Inanna]

I can understand why the doctor has done this and I would support that... Clexane on board during labour can cause catastrophic bleeding. Ceasing the meds or decreasing them will leave her at risk of a potentially fatal clot in her or perhaps the peril of her child.

I had chosen an induction for Imogen at 38 weeks for this reason - as you know fate had other plans...

If she has a diagnosed clotting disorder and has required anticoagulant therapy for her pregnancy there is no way I would be advising to cease or decrease. The risk whilst it may appear low is an unknown.

She would cease clexane and then 24 hours later hve the induction and she would need ted stockings during labour and clexane is usually continued for a few weeks later...

Being the mother of 6 Angels and given what happened with Imogen - I would not personally be happy with a reduction in clexane.

[Tanya]

Thanks Deb,
I found this and thought it was interesting....

"Women who have had a VTE more than three months previously and who are still receiving a therapeutic dose of LMWH can be switched to a prophylactic dose at 38 weeks' gestation, allowing spontaneous labour to occur. Again, LMWH are withheld at the onset of labour (C2). Alternatively, if a woman wishes to be assured of access to epidural anaesthesia, induction of labour can be offered, with the last dose of LMWH on the day before the day of induction (C2). "

From; eMJA: A Working Group on behalf of the Obstetric Medicine Group of Australasia et al., Anticoagulation in pregnancy and the puerperium

Tanya

[Inanna]

Yes Tanya but a prophylactic dose will vary depending on the condition. 40mgs is usually seen as a prophylactic doseage and one that is generally given during pregnancy for queried or known maternal clotting disorders. (I was on this & I had my last doseage Friday PM and Imogen was born via c/section on Sunday 12Pm). I still bled significantly (I was still on asprin).

I am just saying from the perspective of a mother that has lost numerous babies due to an undiagnosed condition - there was no way I was going to risk a catastrophe - for me that meant I would be induced. I needed the controlled environment.

I wouldn't personally support the cesation of anticoagulant therapy - I would opt for a well informed induction. I am looking through different glasses I know...

[Tanya]

That is excellent, thank you Deb. I have had no experience with this drug and your insight is priceless!!

[Inanna]

I hope it helped darling - I have researched this so much that my obs reckons I deserve a title! I also know that due to my own experiences - and supporting others with similar ones that I am more cautious than some...

I just want to add. I had a myocardial infarction 2 days after Imogen's birth. This was thought to be caused by a clot forming in a cardiac vessel. Clotting issues are at their highest 6 weeks post op OR postpartum...

Anticoagulation should in a diagnosed condition be continued into the postpartum period... I am currently back on the lovely needles with a black and bruised belly because of my recent hiccups...

[Tanya]

So if the 40mgs is usually seen as a prophylactic doseage what is the Low molecular weight heparins that the above link is talking about?

[Inanna]

clexane is low weight molecular heparin. What is considered a prophylactic doseage will depend on the physician & the diagnosis. Generally it's 25-40mgs by subcutaneous injection daily.

ETA: I haven't read the link I will do that after hell hour...

Just an aside - women on LWMH -or clexane will have a managed 3rd stage due to the risk of PPH... Just something that you may not or your client may not have considered. I will try and find some substantiated literature on that for you.

[DeDe]

Hi guys,
I'm currently 25 weeks pregnant and have been taking 100mg of Aspirin and clexane injections daily from the day we found out we were pregnant.
I've had 2 miscarriages, one at 18 weeks and thanks to a fantastic doctor was diagnosed with Prothrombin Gene Mutation (blood clotting disorder).
I have been told I will stop taking the aspirin at 34 weeks and will be induced at 38 weeks. 1 day prior to the induction day I will stop the clexane injections so as to decrease the risk of bleeding out, I can have a ceaser if required or an epidural.
I'm pleased with this as all I want is bub to be safe.
Needles are ok, I get bruising every couple of days and getting worse as the fat roles run out as belly grows.
There are many stories on here from girls who have had similar issues and are now taking clexane and have gone on to have perfectly healthy babies so this gives me lots of hope.
De

[Tanya]

She is planning on having a managed 3rd stage Deb, although she is hoping to allow the cord to stop pausating first... should that be ok.

Good Luck DeDe

[DeDe]

Thanks Tanya,
I have been reading your doula website. Do you travel to Wangaratta?

De

[Inanna]

No - if the placenta is medically managed she will have the shot and the placenta will come away soon after the baby is birthed. Unless, she specifically requests that they hold off - I'm not sure how I feel about that... The Birthing Goddess in me is saying - hold off... The medical side of me is saying: "don't risk a PPH..." (remembering that the risk of bleeding is higher anyway..."

I am thinking if it was me:... I would research it a lot more.... But I do believe that she is at higher risk of bleed... I think I would request it was delayed - give the babe a good 5 minutes - use all the good possies to best affect that. Then go for it...

I will think more and will phone a friend and get back...

[Jules_P]

Hi guys,
I'm currently 25 weeks pregnant and have been taking 100mg of Aspirin and clexane injections daily from the day we found out we were pregnant.
I've had 2 miscarriages, one at 18 weeks and thanks to a fantastic doctor was diagnosed with Prothrombin Gene Mutation (blood clotting disorder).
I have been told I will stop taking the aspirin at 34 weeks and will be induced at 38 weeks. 1 day prior to the induction day I will stop the clexane injections so as to decrease the risk of bleeding out, I can have a ceaser if required or an epidural.
I'm pleased with this as all I want is bub to be safe.
Needles are ok, I get bruising every couple of days and getting worse as the fat roles run out as belly grows.
There are many stories on here from girls who have had similar issues and are now taking clexane and have gone on to have perfectly healthy babies so this gives me lots of hope.
De

Hi DeDe -

This is almost exactly what my OB is doing, except I will be induced one day shy of 39 weeks. We actually set the date at my appointment today. I am stopping aspirin now, and will take my last clexane shot of 40 mg the day before induction. (I should go and update my ticker with my induction date of June 26th!!)

I also have PGM.

My shots are becoming more of a challenge as well, but still not as bad as when I was injecting incorrectly earlier on and I looked like a punching bag!!

Best of luck to you!!

[Tanya]

Thanx Deb, I will have a look through some medical journals and see what i can find.

DeDe, I was born in Wang I am going to Wang today... there is a homebirth meet there (if you are interested let me know, there is one every month) AND my sister lives there Of course I would travel to Wang for a client

xx

[Wishingandhoping]

DeDe, I was born in Wang I am going to Wang today... there is a homebirth meet there (if you are interested let me know, there is one every month

Sorry but I don't understand why DeDe would want to go to a homebirth meet when she has said she is being induced at 38wks to avoid risks associated with having been on clexane/aspirin??

[Inanna]

Homebirth meets are great places to learn about a different approach to birth and parenting. Tanya is a doula and as such is involved in birthing in all settings. DeDe can have a medically managed birth and still have a Doula - AND still be interested in seeking like minded women to connect with.

[Wishingandhoping]

Thanks flowerchild So sort of like going to a nursing mothers get-together even though you are bottlefeeding because you like to talk to women who breastfeed? and you all have babies in common anyway!!